[Clinical guidelines for the management of schizophrenia (ΙΙ): Community service-level interventions and the role of Primary Care].

Schizophrenia is one of the most disabling disorders globally, with a significant impact on the professional, social and personal functioning of those affected. Mortality rates are estimated to be 2-2.5 times greater than in the general population attributable to not only suicide but also physical illnesses, such as cardiovascular, metabolic and infectious diseases. Patients with schizophrenia have increased needs for health services which vary according to the stage of the illness and the way the disorder affects the patient. A significant part of the costs of treating patients with schizophrenia is attributed to the health service costs, both to address the disorder itself and its wider effects. In 2015 the National Clinical Guidelines for the management of schizophrenia were formulated by a Working Group that was set up by the Greek Ministry of Health. In this article, a summary of the recommendations (as included in the National Clinical Guidelines) is presented, describing the role of primary care and community mental health services in the management of schizophrenia. The NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia was utilized as the main guide to develop the Greek National Guidelines . In addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA, 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists, 2005), as well as other relevant sources were also used. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. Special effort was made to adapt the international experience to the current Greek landscape with its constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. The proposals aim to contribute to the efficient implementation of the provision of community mental health services for patients suffering from psychotic disorders, focusing in particular on: (a) the role of primary health care services and the role of family physician in the treatment of schizophrenia; (b) the cooperation and coordination between mental health services and primary care services in order to ensure continuity of care (c) designing services that deliver evidence-based interventions,thus ensuring that a larger proportion of the population receives interventions with documented effectiveness in the treatment of schizophrenia, in the least restrictive environment. A particular emphasis is placed on services that are expected to reduce the need for hospitalization, such as crisis intervention services, community interventions aimed at maintaining and continuing the treatment of difficult patients who tend to be lost to follow up from services and early intervention services in psychosis.

Macroinvertebrate and fish communities in the watershed of a re-constructed Mediterranean water body: link to the ecological potential.

The role of benthic macroinvertebrate and fish communities for assessing the ecological quality of an artificial re-constructed, after 50 years of dryness, Mediterranean water body (Karla Reservoir, Greece) is presented. Moreover, we provide knowledge on the structure of the biological communities and their functioning role, for inspiring feature actions that will contribute to biodiversity protection and ecosystem services. Water (physicochemical parameters), benthic macroinvertebrates, and fish were monitored during a 2-year survey (2013-2015) in Karla and Kalamaki reservoirs and the inflowing ditches. A clear temporal pattern was evident for all sampling stations studied, differentiating the low- and high-flow period samples as to their physicochemical parameters. Redundancy analysis (RDA) revealed NO3-N, total nitrogen and total dissolved phosphorous as the most significant environmental parameters in explaining benthic invertebrate variance in ditches. Generally, tolerant to organic pollution macroinvertebrate taxa were abundant in ditches and reservoirs, while the fish fauna in Karla was composed almost exclusively of planktivorous and invertivorous species. Macroinvertebrate (GLBiI) and fish (GLFI) indices classified the ecological quality of Karla Reservoir as "poor" while ditches were classified as "bad" according to HESY-2. The anthropogenic pressures applied in the catchment and the benefits of improving water quality are discussed in the context of the implementation of Water Framework Directive 2000/60/EC for introducing sustainable management plans, taking into account some ecological restoration principles.

[Clinical guidelines for the management of schizophrenia: Pharmacological and psychological interventions (III)].

In 2014 a Working Group was set up by the Greek Ministry of Health, with the objective of formulating Clinical Guidelines for the management of schizophrenia which include recommendations for the pharmacological and the psychosocial treatment of schizophrenia. This Working Group utilized the NICE Guideline (National Institute of Clinical Excellence 2014) for the management of Psychosis & Schizophrenia as the main guide in the development of the Greek guidelines, and in addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA, 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists 2005), as well as other relevant sources. Furthermore, the Hellenic Psychiatric Association (HPA) established an Expert Committee that contributed with its observations to this exercise. With regard to the pharmacological management of schizophrenia, recommendations for initiating and monitoring drug therapy, treating the first psychotic episode as well as treating the acute as well as the maintenance phase of the illness are included. Also included is the management of treatment resistance as well the management of dual diagnosis patients and rapid tranquilization. The guidelines for the psychological treatment of schizophrenia include general recommendations covering all different types of interventions but also specific suggestions for the psychological interventions that should be utilized in the treatment of schizophrenia. In this article the summary recommendations (incorporating the Hellenic Psychiatric Association comments) regarding the pharmacological, psychological and psychosocial interventions in the treatment of schizophrenia are presented.

[Clinical guidelines for the management of schizophrenia:Aims and limitations (Ι)].

The initiative for the development of national treatment guidelines, dates back to the '90s. In Greece, however, National Clinical Guidelines for the management of schizophrenia were first formulated in 2014 when a Working Group was set up for this purpose by the Greek Ministry of Health. The objective of this Working Group was to provide evidence-based recommendations covering the pharmacological and psychosocial treatment of schizophrenia as well as the development of appropriate treatment services. The Working Group utilized the NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia as the main guide to develop the Greek National Guidelines , and in addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists 2005) , as well as other relevant sources. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. A special effort was made to adapt the international experience to the current Greek landscape with the constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. After the preparation of the draft guidelines, a thorough consultation followed with the relevant stakeholders, including mental health professionals, user associations and representatives of the Greek Ombudsman. Additionally, the Hellenic Psychiatric Association established an Expert Committee in Spring 2016, that contributed with its observations to the final exercise. This article will be followed by two further publications (incorporating the Hellenic Psychiatric Association comments) which include: (1) the summary recommendations regarding the pharmacological, psychological and psychosocial interventions in the treatment of schizophrenia, and (2) the summary recommendations regarding: (a) the role of primary health care service and the role of the family physician in the treatment of schizophrenia (b) the summary recommendations regarding continuity of care and c) the summary recommendations regarding community interventions with documented effectiveness in the treatment of schizophrenia.

Trauma, solitary bone cyst and delayed eruption of permanent mandibular incisors. an unusual case in a 7-year-old patient.

BACKGROUND: Solitary bone cysts (SBC) are uncommon non-neoplastic bone lesions, which present mainly in the mandible. Their aetiology is still obscure, but it has been suggested that they may be a result of trauma in the region. Due to their asymptomatic nature, SBCs are revealed mainly accidentally during routine radiographic examination. Sometimes, patients complain of pain or delayed eruption of teeth. Treatment is recommended because, otherwise, the cyst may become symptomatic or cause a pathologic mandibular fracture. CASE REPORT: A 7-year-old Caucasian boy presented with delayed eruption of his permanent incisors. His parents reported a history of trauma at 3 years of age. The radiographic examination revealed a bony lesion, largely displacing the permanent incisors and preventing their eruption. TREATMENT: Surgical exploration of the lesion was carried out and the histopathological examination result was consistent with a SBC. FOLLOW-UP: Two years after the surgical curettage there was radiographic evidence of considerable bony regeneration. The permanent incisors erupted and were vital. CONCLUSION: Clinicians should be aware that SBC is associated with trauma, mainly of the mandible, and with a possible delay of eruption of the corresponding teeth.

Benign fibroxanthoma of the mandible.

Histiocytomas constitute a large group of tumors, the classification of which created a lot of confusion in the past. For this reason, various attempts were carried out during the last years so that a widely accepted classification system could be defined. Fibroxanthomas, according to contemporary data, are classified into benign histiocytomas and they are mostly located at the skin of extremities. They are rarely localized in the area of the head and neck, where they are found commonly in soft tissue. Fibroxanthomas located at the bones of oral and maxillofacial region are extremely rare. The purpose of this paper is to present a case of a fibroxanthoma located at the mandible as well as to analyze the histological findings of the lesion on which the diagnosis and differential diagnosis were based.

Perennial-like adaptation mechanisms of annual legumes to limited irrigation.

The hydrodynamic behavior of two annual legumes (Trifolium angustifolium L. and Onobrychis caput-galli (L.) Lam.) under water shortage was studied in a rain shelter experiment. Seeds were collected from natural grasslands of northern Greece and were sown in pots. Two months after seedlings' emergence, full irrigation (up to field capacity) and limited irrigation (40% of field capacity) were applied. During the vegetative period the leaf water potential and the relative water content were measured at seven day intervals in both treatments. T. angustifolium retained the lowest values of psi both under full (-0.11 to -1.78 MPa) and limited irrigation (-0.16 to -2.90 MPa), while the highest values in both cases were those of O. caput-galli (-0.05 to -0.5 MPa). The results suggested that T. angustifolium was the species mostly affected by limited water supply. T. angustifolium seemed to display adaptation mechanisms to drought similar to those of perennial plants. O. caput-galli displayed a more isohydric behavior by not altering its water potential under limited irrigation.

Traumatic occipital meningoencephalocele presenting with homonymous hemianopia in a professional driver.

BACKGROUND: This study presents the case of a 32-year-old male who is a chronic headache sufferer. He is a professional driver who presented with homonymous hemianopia secondary to a traumatic occipital meningoencephalocele. This is the first time such an association has been reported. CONCLUSIONS: The complete lack of previous visual symptoms supports the belief of late development of the hemianopia. However, the chronicity and the nature of the patients' headaches could have justified further investigations in the past.

Physiology of bone turnover and its application in contemporary maxillofacial surgery. A review.

UNLABELLED: Backround: Bone formation and remodelling appear as normal developmental or healing processes being inducted by several factors as BMPs, biophysical forces and IGF. A local environment consisted of those factors is created and it is responsible for the changes in the direction bone formation-bone resorption. This exact dynamic property of the bone is evaluated and utilized in the reconstructive surgical treatment of craniofacial deformities. METHODS: Data with regard to the physiology of the biological process of bone turn over are initially analysed, followed by the applications of these mechanisms in orthognathic surgery, cleft lip and palate surgery and reconstructive surgery of midfacial deformities, including experimental data after a review of the contemporary international bibliography.Results-Conclusion: The growing knowledge of bone physiology will influence future surgery techniques and that is going to lead to greater therapeutic capabilities for our patients.

Surveillance of glaucoma medical therapy in a Glasgow teaching hospital: 26 years' experience.

AIMS: To report the initial findings of a unique database of 956 patients with ocular hypertension (OHT), normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) attending the Glaucoma Clinic at Glasgow Royal Infirmary, Glasgow, UK. METHOD: The database contains retrospective data from 1981 and prospective data from 1999. Analyses have been carried out using specially written queries to generate reports relating to prescription trends and reasons for treatment discontinuation. RESULTS: The database included the following numbers of patients: POAG 580; OHT 242; NTG 134. Of 2928 treatment-change episodes recorded, failure to reach or maintain a target intraocular pressure (IOP) accounted for 51.9%, while adverse effects accounted for 22.1%. Use of latanoprost has increased sharply since 1996, and that of brimonidine, betaxolol and dorzolamide has declined significantly. Bimatoprost had a higher rate of discontinuation due to adverse effects (25%) than travoprost (16.3%) or latanoprost (12.4%), but this was only statistically significant between latanoprost and bimatoprost (p = 0.0038). In 2000 the database informed the introduction of a new treatment protocol that resulted in a fall in discontinuations due to adverse effects by almost two-thirds. CONCLUSION: A large and unique treatment database has been established at the Glaucoma Clinic of Glasgow Royal Infirmary. Containing data spanning a 26-year period, it promises to be an invaluable resource for audit and research. It has already demonstrated its worth by informing changes in prescribing practice that have resulted in direct patient benefit.

Investigation of seismicity after the initiation of a Seismic Electric Signal activity until the main shock.

The behavior of seismicity in the area candidate to suffer a main shock is investigated after the observation of the Seismic Electric Signal activity until the impending main shock. This is based on the view that the occurrence of earthquakes is a critical phenomenon to which statistical dynamics may be applied. In the present work, analysing the time series of small earthquakes, the concept of natural time chi was used and the results revealed that the approach to criticality itself can be manifested by the probability density function (PDF) of kappa(1) calculated over an appropriate statistical ensemble. Here, kappa(1) is the variance kappa(1)(=-(2)) resulting from the power spectrum of a function defined as Phi(omega)= summation operator(k=1)(N) p(k) exp(iomegachi(k)), where p(k) is the normalized energy of the k-th small earthquake and omega the natural frequency. This PDF exhibits a maximum at kappa(1) asymptotically equal to 0.070 a few days before the main shock. Examples are presented, referring to the magnitude 6 approximately 7 class earthquakes that occurred in Greece.

Oral acetazolamide: A treatment option for blepharochalasis?

This is a report of a middle-aged male with blepharochalasis, who was successfully treated with oral acetazolamide. To our knowledge, this is the first case in the literature reporting the benefits of the use of acetazolamide in the treatment of blepharochalasis.

Attempt to distinguish long-range temporal correlations from the statistics of the increments by natural time analysis.

Self-similarity may originate from two origins: i.e., the process memory and the process' increments "infinite" variance. A distinction is attempted by employing the natural time chi . Concerning the first origin, we analyze recent data on seismic electric signals, which support the view that they exhibit infinitely ranged temporal correlations. Concerning the second, slowly driven systems that emit bursts of various energies E obeying the power-law distribution--i.e., P(E) approximately E(-gamma)--are studied. An interrelation between the exponent gamma and the variance kappa1(identical with - ) is obtained for the shuffled (randomized) data. For real earthquake data, the most probable value of kappa1 of the shuffled data is found to be approximately equal to that of the original data, the difference most likely arising from temporal correlation. Finally, it is found that the differential entropy associated with the probability P(kappa1) maximizes for gamma around gamma approximately 1.6-1.7 , which is comparable to the value determined experimentally in diverse phenomena: e.g., solar flares, icequakes, dislocation glide in stressed single crystals of ice, etc. It also agrees with the b value in the Gutenberg-Richter law of earthquakes. In addition, the case of multiplicative cascades is studied in the natural time domain.

Entropy of seismic electric signals: analysis in natural time under time reversal.

Electric signals have been recently recorded at the Earth's surface with amplitudes appreciably larger than those hitherto reported. Their entropy in natural time is smaller than that of a "uniform" distribution. The same holds for their entropy upon time reversal. Such a behavior, which is also found by numerical simulations in fractional Brownian motion time series and in an on-off intermittency model, stems from infinitely ranged long range temporal correlations and hence these signals are probably seismic electric signal activities (critical dynamics). This classification is strikingly confirmed since three strong nearby earthquakes occurred (which is an extremely unusual fact) after the original submission of the present paper. The entropy fluctuations are found to increase upon approaching bursting, which is reminiscent of the behavior identifying sudden cardiac death individuals when analyzing their electrocardiograms.

Natural entropy fluctuations discriminate similar-looking electric signals emitted from systems of different dynamics.

Complexity measures are introduced that quantify the change of the natural entropy fluctuations at different length scales in time series emitted from systems operating far from equilibrium. They identify impending sudden cardiac death (SD) by analyzing 15 min electrocardiograms, and comparing to those of truly healthy humans (H). These measures seem to be complementary to the ones suggested recently [Phys. Rev. E 70, 011106 (2004)]] and altogether enable the classification of individuals into three categories: H, heart disease patients, and SD. All the SD individuals, who exhibit critical dynamics, result in a common behavior.

Entropy in the natural time domain.

A surrogate data analysis is presented, which is based on the fluctuations of the "entropy" S defined in the natural time domain [Phys. Rev. E 68, 031106 (2003)]]. This entropy is not a static one such as, for example, the Shannon entropy. The analysis is applied to three types of time series, i.e., seismic electric signals, "artificial" noises, and electrocardiograms, and it "recognizes" the non-Markovianity in all these signals. Furthermore, it differentiates the electrocardiograms of healthy humans from those of the sudden cardiac death ones. If deltaS and deltaSshuf denote the standard deviation when calculating the entropy by means of a time window sweeping through the original data and the "shuffled" (randomized) data, respectively, it seems that the ratio deltaSshuf /deltaS plays a key role. The physical meaning of deltaSshuf is investigated.